Hypothyroidism Made Simple (Sort Of)

Let’s talk about something that’s on a lot of people’s minds: hypothyroidism. It’s incredibly common, and while it can be complex, if you understand how to approach it, managing it doesn’t have to be overwhelming.

Hypothyroidism simply means your thyroid isn’t functioning optimally. The symptoms can be wide-ranging—feeling cold all the time, constipation, dry skin, fatigue, brain fog, and more. Thyroid hormones interact with so many systems in the body, so when things are off, it can show up in unexpected ways.

Now, the most important question to start with is: why?Why is the thyroid underperforming?

One of the most straightforward reasons is surgical removal. If your thyroid was removed, you will have hypothyroidism. That’s usually easy to manage—you just replace the missing hormones. You check labs like TSH, free T3, and free T4 maybe once a year. I educate my patients about symptoms of both hypo and hyper thyroidism, especially if they start experiencing things like palpitations. That could be a sign they’ve become overmedicated, which can happen.

But what if you haven’t had surgery?

That’s where things get trickier. The easiest and most helpful step is to get a full thyroid panel. Conventional medicine tends to use just TSH as a screening tool, and while that might be fine for many people, it’s not always enough—especially if you’re experiencing symptoms but your TSH is “normal.”

In my practice, we go deeper. That means running labs like:

• TSH

• Free T3

• Free T4

• Reverse T3

• TPO antibodies

• Thyroglobulin antibodies

When we have that full spectrum, we can ask better questions. Is the TSH showing hypothyroidism? If so, are free T3 and free T4 in the normal range? And if they are, what’s really going on?

If antibodies are elevated, there’s a strong chance the issue is autoimmune, most commonly Hashimoto’s thyroiditis. That’s when your immune system is attacking your thyroid. Not every case of Hashimoto’s can be reversed, but some can. And even if we can’t reverse it entirely, we might be able to optimize outcomes—reduce medication needs, or just help you feel better. And that in itself is a win.

That’s something conventional medicine tends to overlook: we’re not just treating lab numbers. We’re supposed to be helping people feel good and live well, with minimal side effects or complications.

If your adrenal glands aren’t producing cortisol, or if your thyroid hormones are out of balance, we need to measure what's going on. I meet a lot of people who try to “wing it” with natural approaches, without checking labs. But one of the best lessons I’ve learned in medicine is: if you don’t measure it, you can’t improve it.

And I wish they had emphasized that in medical school.

So, if you’re struggling with symptoms and you’ve been told “your labs are normal,” it might be time for a deeper conversation. Ask your physician to run a full panel. If they’re not willing, seek out someone who will. That’s what we do in functional medicine—we try to see the full picture. And while we don’t always find the root cause, when we do, we have a real opportunity to make a difference.

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Yoon Hang Kim MD

Functonal Nomad MD

www.yoonhangkim.com